ANTI-INFLAMMATORIES HURT MY HEART?

June 29, 2011 in Arthritis, Medications
Tags: Advil, Aleve, anti-inflammatory, Arthrotec, cardiovascular, Celebrex, celecoxib, Diclofenac, heart attack, ibuprofen, Motrin, naproxen, NSAID, pain relievers, Rofecoxib, safest for your heart, Vioxx

No one really thinks much about popping a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin), naproxen (Aleve), or Celebrex, for minor complaints, but we should give it more thought. A 9-year study, based on detailed registry data of more than 1 million NSAID users, that was completed last year found that certain pain relievers can increase cardiovascular risk, even in healthy people. The researchers looked at several different types of NSAIDs and this is what they found:

• Ibuprofen — 29% greater risk for fatal or nonfatal stroke;
• Rofecoxib (Vioxx) — 66% increased risk for cardiovascular death. (Remember the high rate of heart attack and stoke is why it was taken off the US market back in 2004.);
• Diclofenac (Arthrotec) — 91% increased risk for cardiovascular death. (Diclofenac has high COX-2 inhibition selectivity.)
• Celecoxib — findings inconclusive. The number of events was too small but available data did seem to show a trend for increased cardiovascular risk;
• Naproxen (Aleve) — NOT associated with any increased cardiac risk.

That why these researchers say naproxen is the safest choice for your heart.  As with any new medical regimen, always consult your physician first.

Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.

PSEUDOGOUT 101

June 17, 2011 in Arthritis, Pseudogout
Tags: Anti-inflammatory medications, calcium pyrophosphate, calcium pyrophosphate deposition disease, chronic disability, damaged cartilage, excess iron storage, genetic factors, hemochromatosis, hypercalcemia, hypothyroidism, indomethacin, localized pain, mistaken for gout, misunderstood arthritis, naproxen, nonsteroidal anti-inflammatory drugs, on-going inflammation, osteoarthritis, parathyroid gland, poor kidney function, Proper diagnosis, rheumatoid arthritis, severe joint degeneration, stomach ulcers, swollen or painful joint, underactive thyroid

Pseudogout may be one of the most misunderstood forms of arthritis, often mistaken for gout and other conditions. Proper diagnosis is important, though, because untreated pseudogout may lead to a severe form of joint degeneration and on-going inflammation, resulting in chronic disability.  Anyone can develop pseudogout; risk greatly increases with age.  Proper diagnosis depends on identifying the causative calcium pyrophosphate crystals found in the fluid of an affected joint.  Anti-inflammatory medications may be prescribed to prevent or control joint symptoms.

What is pseudogout?

Pseudogout is a type of arthritis that, as the name implies, can cause symptoms similar to gout but in reaction to a different type of crystal deposit. Pseudogout, sometimes referred to as calcium pyrophosphate deposition disease, can cause severe episodes of localized pain and swelling resulting in incapacitation for days or weeks. It also can cause more chronic arthritis that mimics osteoarthritis or rheumatoid arthritis. Knees most often are involved, but wrists, shoulders, ankles, elbows or hands can be affected.

Pseudogout develops when deposits of calcium pyrophosphate crystals accumulate in a joint. Crystals deposit first in the cartilage and can damage the cartilage. The crystals also can cause a reaction with inflammation that leads to joint pain and swelling. In most cases it is not known why the crystals form, although crystal deposits clearly increase with age. Because the condition sometimes runs in families, genetic factors are suspected of contributing to the disorder, as can a severely underactive thyroid (hypothyroidism), excess iron storage (hemochromatosis), low magnesium levels in blood, an overactive parathyroid gland, and other causes of excessive calcium in the blood (hypercalcemia).

The calcium crystal deposits seen in pseudogout affect about 3 percent of people in their 60s and as many as 50 percent of people in their 90s. Any kind of insult to the joint can trigger the release of the calcium crystals, inducing a painful inflammatory response. Attacks of pseudogout also can develop following joint surgery or other surgery. However, not everyone will experience severe attacks.

Diagnosis is made on the basis of symptoms and medical tests. The physician will use a needle to take fluid from a swollen or painful joint to determine whether calcium pyrophosphate crystals are present. An X-ray of the joint may be taken to determine whether calcium-containing deposits are present in the cartilage, creating a condition known as chondrocalcinosis. Other potential causes of symptoms must be ruled out. Pseudogout often is present in people who have osteoarthritis.

The doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin) and naproxen (Naprosyn) to treat pain and disability during severe episodes of pseudogout. Then, to prevent further attacks, low doses of colchicine or NSAIDs may prove effective. However, no treatment is available to dissolve the crystal deposits, and those with poor kidney function, a history of stomach ulcers and/or on blood thinners often cannot take NSAIDs. These patients may find a corticosteroid injection into the affected joint a useful option.

It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as hemochromatosis (too much iron stored in the body), or parathyroid problems, treatment of that condition may prevent progression of other features of that potentially dangerous illness and may, in some cases, slow the development of pseudogout.

Diagnosis is confirmed by microscopic identification of calcium pyrophosphate crystals. Anti-inflammatory agents can help lessen symptoms, but there is currently no way to eliminate the crystals themselves

Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com.

LUPUS-DIET

February 3, 2011 in Lupus Diet, Our Recent Posts
Tags: celecoxib, exercise, fatigue, fish, fresh fruits, heartbeats, lupus, lupus flares, meat, naproxen, nutritious diet, omega-3-fatty acid, poultry, rheumatologist, sleep well, UV, UVA, UVB, vegetables, whole grains

Despite numerous resources on the Internet and claims in various books, there is no special diet for lupus. Generally, patients with lupus should try to eat a well-balanced, nutritious diet that is enriched with whole grains, fresh fruits and vegetables, and moderate amounts of poultry, meat, and fish. Fish oil, or Omega-3 fatty acid, has been found to help reduce inflammation and the risk of coronary artery disease.

In addition, it may also protect against irregular heartbeats and help lower blood pressure. Due to the fact that patients with lupus have an increased risk of heart disease than the general population, omega-3 fatty acids are of importance.

Patients with lupus should avoid alfalfa as it has been associated with reports of a lupus-like syndrome or lupus flares. Lupus-like symptoms may include muscle pain, abnormal blood test results, kidney problems, fatigue, and changes in immune system function. It is thought these reactions are due to an amino acid that is found in alfalfa seeds and sprouts (not in leaves) that activates the immune system and increases inflammation.

Certain items from your diet may need to be eliminated or reduced because of medications you may be taking or because of organ damage due to lupus. Alcohol can lower the efficacy of some drugs and can make existing problems worse. Patients with lupus may be taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or celecoxib. These medications carry a risk of developing an ulcer that is increased with alcohol use. If you are taking steroids you should limit the amount of fat and salt in your diet as corticosteroids can elevate blood pressure and the levels of cholesterol and lipids in your blood. In addition, they can also cause or worsen osteoporosis, a condition in which bones are at an increased risk of fracture due to fragility. Foods rich in calcium, such as dark green leafy vegetables (spinach, broccoli, collard greens), milk, cheese, and yogurt or calcium supplements that contain vitamin D, should be consumed to help with bone growth.

LUPUS AND EXERCISE

People with lupus need to exercise regularly just like everyone else. Activities such as swimming, walking, low-impact aerobics, bicycling, yoga, pilates, or stretching will help strengthen your bones and tone your muscles without aggravating inflamed joints. Regularly engaging in these activities will also help reduce the risk of developing osteoporosis. Activities such as high-impact aerobics, jogging, or weight lifting should be limited or avoided if you are experiencing muscle pain or swollen joints. The benefits of regular exercise include reducing or minimizing stress, increasing your range of motion, improving muscle stiffness while increasing muscle strength, and helping to prevent osteoporosis and keep your heart healthy.

The majority of patients with lupus experience fatigue – approximately 80%. At times, this can be debilitating to the point of interfering with their daily activities. Regular exercise and being involved in a support group seem to be of great benefit. Some tips of dealing with fatigue include alternating activities with periods of rest throughout the day, establishing good sleep patterns, eating a healthy diet, and stop smoking.

LUPUS AND SUN EXPOSURE

Approximately two-thirds of people with lupus are sensitive to ultraviolet rays (UV) – from sunlight or artificial light. Regardless of the degree of sensitivity, you should limit the exposure to UV rays as excessive exposure can cause lupus to flare. Every person with lupus should use sunscreen with a sun protection factor (SPF) of at least 30 that blocks both ultraviolet A (UVA) and ultraviolet B (UVB) rays. In addition, wearing proper clothing helps too, such as broad-rimmed hats, long-sleeved shirts, and pants. UVB rays are most intense between 10am and 4pm so you should plan your day accordingly. UV rays are stronger at higher altitudes and when reflected by snow or water. Please consult with your rheumatologist to develop an appropriate treatment plan designed for you.

Rodney Bluestone Medical doctors are rheumatology specialists located in Los Angeles, California. We provide treatment for all types of arthritis including osteoarthritis, gout, rheumatoid arthritis and lupus. For more information, including treatment and symptoms of arthritis, please visit www.rodneybluestonemedical.com